Parenting and childcare responsibilities, harm reduction service engagement, and opioid overdose among women and men who use illicit opioids in New York City

BACKGROUND: Little is known regarding relationships among parenting, engagement in harm reduction services, and overdose risk among people who use illicit opioids (PWUIO), and whether associations differ by gender. METHODS: Using baseline data from an ongoing study among PWUIO in New York City (n = 575), we measured childcare factors (i.e., residing with children, avoidance of drug treatment for fear of child welfare, difficulty accessing harm reduction due to childcare issues), and harm reduction services and overdose-related outcomes. Among those with children, we estimated prevalence ratios (PR) using modified Poisson regression with a product-interaction term for gender differences. RESULTS: In the total sample (n = 575), approximately 70% reported having children. Compared to men, women were more likely to reside with children (25% vs 36%; p-value=0.04), avoid treatment for fear of child welfare (16% vs 26%; p-value=0.04), and less likely to be trained in naloxone administration (68% vs 61%; p-value=0.09). Among participants with children (n = 403), residing with children was associated with naloxone training among men (aPR 1.28, 95% CI: 1.01, 1.62). Avoiding treatment for fear of child welfare was associated with carrying naloxone overall (aPR 0.68, 95% CI: 0.46, 0.99), with a stronger association among women (aPR 0.48, 95% CI: 0.26, 0.92). Difficulty accessing services due to childcare was associated with lifetime overdose (aPR 1.53, 95% CI: 1.05, 2.23). CONCLUSION: Childcare responsibilities may be a barrier for accessing substance use services and treatment for men and women. Further qualitative and mixed-methods research is needed to understand how to make treatment and services accessible for parents.